Plasma levels of CEA as a prognostic marker in carcinoma of urinary bladder.

Plasma carcinoembryonic antigen (CEA) levels were performed preoperatively by radioimmunoassay in 124 patients with histologically proved bladder carcinoma. The level of CEA was used to determine its prognostic value in patients with bladder cancer. The correlation of CEA levels with the stage of the disease, histology, and resectability was also studied. Values above 2.5 ng/ml were taken as abnormal. Active disease was associated with high CEA levels. All patients with CEA levels greater than 10 ng/ml died in less than 1 1/2 years, while all patients who survived 1 1/2-3 years had preoperative CEA levels less than 10 ng/ml. There was a prognostic significance for patients with transitional cell or squamous cell carcinoma. All patients with squamous cell carcinoma had CEA levels less than or equal to 10 ng/ml, and all patients with transitional carcinoma had preoperative CEA values greater than 10 ng/ml. A correlation between CEA levels and resectability of the primary tumor was found. This study indicates that, in bladder carcinoma patients, preoperative CEA levels greater than 10 ng/ml are of prognostic value, since all of these patients have died and all of the long-term survivors had levels of less than or equal to 10 ng/ml.     

Preoperative high CEA level in lung cancer patients: significant of measurement of serum CEA level among preoperative and postoperative course in long time observed patient]

We measured pre- and postoperative CEA level in 330 patients who underwent resection for lung cancer at Kyushu Cancer Center Hospital between 1983 and 1986 using RIA method. There were 93 patients with high preoperative serum CEA level above 5 ng/ml. The interrelationships among preoperative serum CEA level, prognostic factors, outcome, and postoperative change of CEA level were investigated in the 93 patients. Five-year survival rate of patients with preoperative serum CEA level ranging from 5.0 to 10.0 ng/ml (N = 53) was 60.0%, while that of patients with preoperative CEA level over 10.1 ng/ml (N = 40) was 24.6% (P less than 0.05). Recurrent rate was higher in patients with preoperative CEA level over 10.1 ng/ml, especially in those with lung cancer at stages I or II. However, patients with preoperative CEA level about 50 ng/ml, showed good outcome after curative resection. All 12 patients in whom postoperative serum CEA level did not return to normal died within 4 years, indicating that normalization of CEA level is an important factor in prognosis. This study indicates that among lung cancer patients with high serum CEA level, the preoperative CEA level and postoperative change of CEA level are apparently prognostic factors.     

Serum carcinoembryonic antigen level in non-small-cell lung cancer patients with preoperative normal serum level

Objective  The prognostic significance of serum carcinoembryonic antigen (CEA) levels in non-small-cell lung cancer (NSCLC) patients with a normal serum CEA level (<5.0 ng/ml) was examined. Methods  A total of 220 consecutive NSCLC patients with preoperative normal serum CEA levels were included. Patients were subdivided into two groups: preoperative serum CEA level ≥2.5 and <2.5 ng/ml. Results  The 5-year survival of patients with preoperative serum CEA level less and more than 2.5 ng/ml were 79.62% and 62.0%, respectively (P = 0.0036). Multivariate analysis indicated that a preoperative serum CEA level of ≥2.5 ng/ml was an independent prognostic factor. Similar results were found in patients with adenocarcinoma but not found in others. Conclusion  NSCLC patients with a high serum CEA level, especially adenocarcinoma patients, had poorer prognosis even if their serum CEA levels were within the normal upper limit.     

CEA levels of draining venous blood and draining-peripheral CEA gradient in colorectal cancer patients: correlation with postoperative survival

Correlation between preoperative CEA levels in draining venous blood (d CEA) and draining-peripheral (d-p) CEA gradient, and postoperative survival of 94 patients with colorectal cancer patients was examined. The positive rates of d CEA and d-p CEA gradient greater than 5 ng/ml (55.9% and 37.2%) in 59 alive patients were significantly (p less than 0.05) lower than those (77.1% and 57.1%) in 35 patients died of cancer recurrence within 4 years. Survival curve of the patients with positive d CEA and d-p CEA gradient were significantly (p less than 0.01) lower than those of the patients with negative d CEA and d-p CEA gradient. Survival curve of the patients with d-p CEA gradient greater than 10 ng/ml was significantly (p less than 0.001) lower than that of the gradient less than 10 ng/ml, and 4-year survival rates were 37.5% in the former patients and 68.3% in the latter patients. These results suggest that d CEA and d-p CEA gradient may be used as prognostic indicators of colorectal cancer patients. Clinically, the patients with positive d-p CEA gradient greater than 10 ng/ml are necessary to be treated as patients having very poor prognosis.     

Prognostic value of carcinoembryonic antigen and CYFRA21-1 in patients with pathological stage I non-small cell lung cancer.

BACKGROUND: The aim of this retrospective study was to assess the prognostic value of serum tumor markers (carcinoembryonic antigen (CEA) and CYFRA21-1) in patients with pathologic (p-) stage I non-small cell lung cancer (NSCLC) undergoing complete resection. METHODS: Two hundred and seventy-five patients (163 males, 112 females, mean age 67.1 years) with p-stage I NSCLC who underwent complete resection at our institution between April 1999 and October 2004 were examined. Patients who had received preoperative chemotherapy or radiotherapy were excluded, as were patients who had multiple malignancies including multiple lung cancer. The serum levels of tumor markers were measured using commercially available immunoassays within 1 month before surgical resection. Serum levels of CEA and CYFRA21-1 higher than 5.0 and 2.8 ng/ml, respectively, were considered as positive according to the manufacture's instructions. RESULTS: The histological classification was adenocarcinoma in 193 patients, squamous cell carcinoma in 71, large cell carcinoma in 5, and other histological type in 6. One hundred and fifty-seven patients had T1 disease and 118 patients had T2 disease. The positive ratio of CEA and CYFRA21-1 was 25.7% and 13.7%, respectively, and in relation to histological type was 27.8% and 7.8% in adenocarcinoma, and 20.6% and 28.4% in squamous cell carcinoma. The overall 5-year survival rate was 79.3%. With a median follow-up of 35.5 month for surviving patients, those with initial CYFRA21-1 serum levels higher than 2.8 ng/ml had a significantly worse prognosis (p=0.0041). Patients with an elevated preoperative CEA level exceeding 5.0 ng/ml had a shorter disease-free survival period (p=0.0003). In patients with adenocarcinoma, a CEA level above 5.0 ng/ml was associated with shorter survival and early recurrence, whereas CYFRA21-1 showed no such association. In patients with squamous cell carcinoma, elevated preoperative CEA was not related to survival and recurrence. In these patients, preoperative CYFRA21-1 level exceeding 2.8 ng/ml was associated with a poorer outcome, whereas preoperative CYFRA21-1 level was not associated with cancer recurrence. CONCLUSION: The patients with p-stage I adenocarcinoma whose preoperative CEA level was high might be considered as good candidates for adjuvant chemotherapy. The prognostic value of CYFRA21-1 could not be confirmed for stage I NSCLC, and preoperative CYFRA21-1 level was not useful in selecting the candidates for adjuvant chemotherapy.     

Carcinoembryonic antigen (CEA) assays in obstructive colorectal cancer.

Four of 40 patients with resectable colon or rectal cancer had tumors causing acute large bowel obstruction with colonic dilatation; all 4 patients had preoperative CEA titers above 10 ng/ml with a mean of 28 ng/ml. Thirty-six cancer patients without acute colon obstruction had a mean CEA titer of 4.5 ng/ml; only 6 of 36 patients had circulating CEA titers 10 ng/ml or greater. This suggested that pre-treatment CEA titers in patients with obstructing cancer are unusually high. Multiple CEA assays were performed on two of the 4 patients with colonic obstruction before and after bowel decompressive procedures and prior to their definitive treatment. Relief of obstruction alone produces marked reduction in circulating CEA; this suggested that not only the extent of disease but also the pathophysiological changes associated with obstruction influenced circulating CEA levels.     

The prognostic value of carcinoembryonic antigen in T1N1M0 and T2N1M0 non-small cell carcinoma of the lung.

OBJECTIVE: To evaluate the significance of preoperative clinicopathological factors, including serum carcinoembryonic antigen (CEA), as well as postoperative clinicopathological factors in T1-2N1M0 patients with non-small cell lung cancer who underwent curative pulmonary resection. METHODS: Twenty T1N1M0 disease patients and 25 T2N1M0 patients underwent standard surgical procedures between September 1996 and December 2005, and were found to have non-small lung cancer. As prognostic factors, we retrospectively investigated age, sex, Brinkman index, histologic type, primary site, tumor diameter, clinical T factor, clinical N factor, pathological T factor, preoperative serum CEA levels, surgical procedure, visceral pleural involvement, and the status of lymph node involvement (level and number). RESULTS: The overall 5-year survival rate of all patients was 59.6%. In univariate analysis, survival was related to age (<70/>or=70 years, p=0.0079), site (peripheral/central, p=0.043), and CEA level (<5.0/>or=5.0 ng/ml, p=0.0015). However, in multivariate analysis, CEA (<5.0/>or=5.0 ng/ml) was the only independent prognostic factor; the 5-year survival of the patients with an elevated serum CEA level (>or=5.0 ng/ml) was only 33.2% compared to 79.9% in patients with a lower serum CEA level (<5.0 ng/ml). CONCLUSIONS: An elevated serum CEA level (>or=5.0 ng/ml) was an independent predictor of survival in pN1 patients except for T3 and T4 cases. Therefore, even in completely resected pN1 non-small cell lung cancer, patients with a high CEA level might be candidates for multimodal therapy.     

Can Biliary Carcinoembryonic Antigen Identify Colorectal Cancer Patients with Occult Hepatic Metastases?

Background Twenty-five percent of radically treated colorectal cancer patients already have occult hepatic metastases (OHM) that will later be observed during postoperative follow-up. Instrumental examinations, i.e., intraoperative ultrasound or Doppler perfusion index, have not improved diagnosis. As carcinoembyonic antigen (CEA) levels are useful to reveal hepatic metastases from colorectal cancer, determination of CEA in the bile rather than the blood may allow preclinical diagnosis of OHM thanks to the reduced volume of bile. Methods One hundred radically treated colorectal cancer patients were enrolled in the study. Bile was withdrawn from the gallbladder intraoperatively and biliary CEA levels determined using an immuno-enzymatic method (normal value 0–5 ng/ml). Eighty-nine fully evaluable patients were followed up for three years postoperatively to monitor hepatic metastases. Preoperative blood CEA, lymph node metastases and biliary CEA were compared in order to assess which procedure was more efficient in identifying patients who would develop hepatic metastases. Results Eleven of the 89 evaluable patients developed hepatic metastases: 9/11 presented elevated biliary CEA levels (mean: 12.73; range: 5.1–26.2); 8/11 had high preoperative blood CEA values; and 9/11 were at anatomopathological stage N+. In the 78 patients who did not develop hepatic metastases, biliary CEA was within normal limits in 73/78, preoperative blood CEA was normal in 60/78, and 58/78 patients were at anatomopathological stage N−. Hence, the sensitivity of biliary CEA was 81.8%, specificity was 93.6%, and diagnostic accuracy was 92.1%. Conclusions Determination of biliary CEA seems to be more efficient in identifying patients presenting OHM who require frequent clinical examinations or adjuvant cancer treatment.     

Patients with high risk of hematogenous metastasis and recurrence in colorectal cancer: correlation with histopathologic variables and tumor markers, CEA and CA19-9, in peripheral and draining venous blood

Correlations of hematogenous metastasis with histopathologic variables, preoperative CEA and CA19-9 levels in peripheral (p) venous blood, and those in draining (d) venous blood were examined in 78 patients with colorectal cancer. Out of 10 histopathologic variables, location of venous invasion was most significantly correlated with hematogenous recurrence: the rate (11%) of v0 and/or sm-pm v(+) in 50 patients without the recurrence was significantly lower than that (89%) in 28 patients with the recurrence. On the other hand, the rate (68%) of ss-extra(+) in the latter was significantly higher than that (32%) of the former. The mean values (6 and 14 ng/ml) and positive rates (22 and 48%) greater than 5 ng/ml of p and d-CEA in 50 patients without the recurrence were significantly lower than those (14 and 189 ng/ml, 48 and 96%) in 28 patients with the recurrence. Patients with d-p CEA gradient greater than 5 ng/ml were found, respectively, in 34% of the former and 82% in the latter. The mean value (982 U/l) and positive rate (94%) greater than 37 U/ml of CA19-9 in peripheral blood of 28 patients with the recurrence were significantly higher than those (25 U/ml and 11%) of 50 patients without the recurrence. These results suggest that colorectal cancer patients with high risk of hematogenous metastasis and recurrence are the patients with ss-extra(+), the values of d-CEA, especially d-p CEA gradient, greater than 5 ng/ml and with p-CA19-9 value greater than 37 U/ml.     

CEA Monitoring Among Patients in Multi-institutional Adjuvant G.I. Therapy Protocols

The Gastrointestinal Tumor Study Group (GITSG) has since 1975 included protocols for monitoring carcinoembryonic antigen (CEA) levels in its colorectal cancer adjuvant trials. Among the 563 patients on the colon cancer study (GI 6175) and the 207 patients on the rectal cancer study (GI 7175), one third had preoperative CEA determinations and more than 90% had some postoperative CEA monitoring. Colon cancer patients whose preoperative CEA was greater than 5 ng/ml had a greater probability of recurring than those whose values were lower (33% versus 18% recurrence with 21 months minimum follow-up; p < 0.05). The prognostic value of preoperative CEA was apparent only in patients with Dukes' C1 colon tumors. Preoperative CEA values were not of prognostic significance among the rectal adenocarcinoma patients. Although elevated levels of CEA after resection of either colon or rectum cancers were strongly associated with subsequent tumor recurrence, no single CEA value, arbitrarily defined as “elevated”, provided an adequate screening test with both high sensitivity and high specificity. Postoperative CEA elevations were more strongly predictive of recurrence when part of a steadily rising trend. In the colon cancer study, the median monthly increase in CEA for disease-free patients was estimated to be zero, and for the relapsed patients 5.8%. The corresponding estimates for patients on the rectal cancer protocol were zero and 7.8%. Only 36 of the 344 disease-free patients on the colon protocol and 14 of the 94 disease-free patients on the rectal protocol (15%) exhibited a rate of increase of CEA as high as 3% per month over the entire period of observation. Two thirds of the relapsed patients on both studies showed a rate of increase this high or higher. The patterns of CEA rise in individual patients were quite varied, however, and monthly rates of increase as established in our study are not to be used as guidelines in patient management.     

Serum CEA levels in patients with gastric carcinoma correlate with the tumorigenicity of their xenografts in nude mice

We examined the correlation among preoperative serum carcinoembryonic antigen (CEA) levels, staining properties of the tumors by CEA immunohistochemistry and the tumorigenicity of their xenografts in nude mice, in 28 patients with gastric cancer. Eleven (40 per cent) of them were positive for serum CEA (greater than or equal to 2.5 ng/ml) and seven (25 per cent) of the xenografts were tumorigenic in nude mice. All the tumorigenic cases were positive for serum CEA (p less than 0.001) and the mean value of the serum CEA level in the patients with tumorigenic neoplasms was 20.8 ng/ml, being significantly higher than that (1.4 ng/ml) in the patients with non-tumorigenic neoplasms (p less than 0.001). Twenty-five of the 28 carcinomas (89 per cent) were positive for CEA staining in their cancer cells by the ABC method and CEA localization correlated with tumorigenicity (p less than 0.05). These results suggest that the serum CEA level in patients is correlated with the tumorigenicity of their gastric carcinoma xenografts in nude mice and may account for the poor prognosis of patients with high serum CEA.     

Carcinoembryonic antigen (CEA) levels of peripheral and portal blood and tumor histopathology in colorectal cancer

Correlation between CEA levels of peripheral and portal blood and 9 histopathologic variables were examined in 66 patients with colorectal cancer. CEA levels of portal blood (mean 26.6ng/ml and positive rate more than 5ng/ml, 59.1%) were significantly higher than those (8.1ng/ml and 33.3%) of peripheral blood. Elevation of CEA levels in portal and peripheral blood were most highly correlated with the grade of vein invasion and its location in the layer of colorectal wall, although the levels were related to the other 8 histopathologic variables such as tumor size, the grade of node metastases, Dukes stage and so on. CEA levels of portal blood elevated from 19.4ng/ml and 40% to 43.6ng/ml and 90.2% respectively following operative stimuli to cancer lesions with vein invasion, but the levels did not elevated in the lesions without its invasion. CEA levels of peripheral blood were as low as 5ng/ml in 3 out of 8 patients with liver metastases. However, the levels in portal blood were much higher than 5ng/ml in all the patients. These results suggested that CEA might be hematogenously drained by portal system from cancer cells in the invasive veins, but not by thoracic duct of lymphatic system, and also that the measurement of CEA in portal blood might be available to predict the vein invasion of cancer lesions and liver metastases in patients with colorectal cancer.     

Abnormal carcinoembryonic antigen levels and medullary thyroid cancer progression: a multivariate analysis

HYPOTHESIS: Medullary thyroid cancer cells are capable of secreting carcinoembyronic antigen (CEA). An abnormal preoperative CEA level may have important implications for the management of this condition. DESIGN: Retrospective analysis. SETTING: Tertiary referral center at a university hospital. PATIENTS: One hundred fifty patients with a histopathologic diagnosis of medullary thyroid cancer and preoperative CEA measurements using the same assay. Main Outcome Measure We used univariate and multivariate analyses to quantify the relationship between preoperative CEA level and tumor progression. RESULTS: On multivariate analysis, abnormal preoperative CEA levels were significantly associated with the initial operation rather than reoperation, larger primary tumors, positive lymph nodes, and distant metastasis. When analyses were limited to the 54 patients with increased CEA levels before the initial operation, there was a respective significant association between successive CEA levels (4.7-10.0, 10.1-30.0, 30.1-100.0, and >100.0 ng/mL) and lymph node metastases (>10 positive nodes: 0%, 9%, 53%, and 69% [P<.001]), involvement of cervical lymph node compartments (central: 33%, 36%, 73%, and 93% [P=.002]; lateral [ipsilateral]: 20%, 27%, 67%, and 88% [P=.001]; and lateral [contralateral]: 22%, 10%, 36%, and 73% [P=.008]), and distant metastasis (0%, 27%, 13%, and 75% [P<.001]). When CEA levels exceeded 30.0 ng/mL, surgical cure was exceptional. CONCLUSIONS: In medullary thyroid cancer, an abnormal CEA level heralds advanced disease. Carcinoembryonic antigen levels greater than 30.0 ng/mL indicate central and lateral (ipsilateral) lymph node metastases, whereas CEA levels greater than 100.0 ng/mL signify lateral (contralateral) lymph node metastases and distant metastasis.     

Histopathologic and immunohistochemical studies on the elevation mechanism of carcinoembryonic antigen (CEA) in gastric cancer patients

Correlation between carcinoembryonic antigen (CEA) levels of peripheral and draining venous blood, and 11 histopathologic and 2 immunohistochemical variables, was examined in 53 gastric cancer patients and 8 patients with benign diseases. CEA levels of draining blood (with a mean of 136.5 ng/ml and positive rate greater than 5 ng/ml, 58, 3%) were significantly higher than those (30.3 ng/ml, 22.9%) of peripheral blood in patients with CEA producing cancer. However, CEA levels of draining blood were as low as 5 ng/ml and were not different from those of peripheral blood in all of the patients with CEA non-producing cancer and benign diseases. Elevation of CEA levels in draining and peripheral blood was most highly correlated with the venous invasion, although the levels in draining blood were related to other histopathologic variables including tumor size, macro- and microscopic types, invasive layer of gastric wall, peritoneal dissemination, liver and node metastasis, lymphatic invasion and stage classification except tumor location. These variables relating to CEA elevation in the blood were highly correlated with venous invasion. However, tumor location was not found the relation with venous invasion. These results suggest that CEA may be haematogenously drained by the portal system via the draining vein from the CEA producing cancer cells in the invasive veins but not by the thoracic duct of the lymphatic system, and that histopathologic CEA elevation-relating variables may affect secondarily the CEA elevation in the blood in association with the venous invasion.     

Key role of the CEA test in the diagnosis and surgical therapy of recurrent colorectal cancer

Between 1978 and 1984, 87 patients with recurrent colorectal cancer have been operated upon. In 10 of 35 patients with locoregional recurrence and 24 of 52 with distant metastases therapy was potentially curative. Of 87 patients 73 had elevated CEA levels (greater than or equal to 5 ng/ml) at the time of diagnosis. In 65 of 73 patients the CEA increase preceded the recognition of recurrence and in 14 patients the diagnosis could be confirmed only by a second-look operation. Patients with metastases (91.3%) showed CEA elevation more often than those with locoregional recurrence (71.4%). Patients with operable disease had significantly (p less than 0.05) lower CEA values (median 19.7 ng/ml) than those with inoperable recurrent carcinomas (median 36.9 ng/ml).     

Preoperative Serum Carcinoembryonic Antigen Level as a Predictive Factor of Recurrence After Curative Resection of Colorectal Cancer

Background  We evaluated the prognostic value of the preoperative serum carcinoembryonic antigen (CEA) level in patients with colorectal cancer (CRC). Patients and Methods  The study group comprised 638 patients. The optimal cutoff value for the preoperative serum CEA level was determined. Predictive factors of recurrence were evaluated using multivariate analyses. The relapse-free time was investigated according to the CEA level. Results  All patients underwent potentially curative resection for CRC without distant metastasis, classified as stage I, II, or III. The optimal cutoff value for preoperative serum CEA level was 10 ng/ml. Elevated preoperative serum CEA level was observed in 92 patients. Multivariate analysis identified tumor–node–metastasis (TNM) stage and preoperative serum CEA level as independent predictive factors of recurrence. The relapse-free survival between CEA levels >10 ng/ml and <10 ng/ml significantly differed in patients with stage II and III. However, there was no significant difference in relapse-free survival between CEA levels >10 ng/ml and <10 ng/ml in patients with stage I. Conclusion  Preoperative serum CEA is a reliable predictive factor of recurrence after curative surgery in CRC patients and a useful indicator of the optimal treatment after resection, particularly for cases classified as stage II or stage III.     

Relatively high risk of treatment failure after prostatectomy: tumour grade, histopathological stage and the preoperative serum PSA level are key prognosticators

OBJECTIVE: Prostate cancer is the most common malignancy among males in Sweden. Any reduction in morbidity and mortality would require early detection of cases in which curative treatment is achievable. MATERIAL AND METHODS: From 1994 through 1998. 105 patients with clinically localized T1-T2 tumours were subjected to radical prostatectomy at our department. Three patients were lost to follow-up. We obtained clinical information from the patients' medical records and used pathologist reports to characterize the tumours with respect to grade and histopathological stage. We used serum PSA levels as a surrogate end-point, with a level equal to or above 0.6 ng/ml designated as treatment failure. Outcome was examined with respect to tumour grade, histopathological stage and preoperative PSA level. RESULTS: Altogether, 29% of the patients showed PSA failure during follow-up which varied between 2 and 6 years. No mortality due to prostate cancer was recorded during this time period. We found that tumour grade, histopathological staging and as well as the preoperative PSA level correlated with treatment failure (p<0.01). About 80% of the patients with a preoperative PSA <10 ng/ml showed no signs of treatment failure. The corresponding figure for those with PSA above 10 ng/ ml was 55%. The outcome for patients with a PSA between 10-20 did not seem to be better than that for patients with a preoperative PSA >20 ng/ml. CONCLUSION: Our study indicates, that the risk of treatment failure depends strongly on the grade of the tumour and increases when preoperative PSA value is greater than l0 ng/ml.     

AIDS患者血清CEA水平与胸部影像学关系的临床观察

目的：探讨AIDS患者血清癌胚抗原（CEA）增高与胸部病变的关系。方法观察2008年1月至2011年12月间因胸部疾病入住四川省达州市中心医院呼吸内科且确诊为AIDS感染者,选取同时有胸部CT检查及血清CEA检测资料的病例68例,包括男性54例,女性14例,年龄26～78岁,平均年龄51.10岁,分析临床病史、症状、胸部CT影像学变化与血清CEA水平之间的关系。结果68例AIDS患者中,CEA增高者占44.12%,平均年龄较CEA正常组偏大3.22岁;发热、咳嗽症状患者两组间比例接近,主诉气促及合并真菌感染者是CEA正常者的1倍,而乏力盗汗、胸部不适等其他主诉则约是CEA正常者的1/2（47.83%）。CEA正常组的均值是（2.04±1.34）ng/ml,CEA增高组为（8.28±4.54）ng/ml;组间差异有显著统计学意义（P ＜0.001）,CEA增高组发生胸部磨玻璃影（GGO）的几率是CEA正常者的4倍,而CEA正常组斑片影则约为CEA增高组的1倍;AIDS患者胸部GGO影像的密度和范围不同,其CEA的平均水平出现相应的水平差异;而未合并GGO的胸部团块影、纵膈增大及纤维索条影者CEA水平在0.00～10.93 ng/ml,与GGO者比较差异有显著统计学意义（P ＜0.001）。结论 AIDS患者血CEA增高可能与胸部磨玻璃影的形成相关,是CEA的一种非肿瘤性特性,可能与PCP感染相关。     

Preoperative carcinoembryonic antigen levels correlated with postoperative pathological staging in bronchial carcinoma.

Serum carcinoembryonic antigen (CEA) levels were obtained before operation in 214 patients undergoing diagnostic tests for suspected bronchial carcinoma, and the results correlated with the postoperative, pathological stage of disease. Positive CEA levels (greater than 10 ng/ml) were observed in 40% (8/20) of stage 1, 58.5% (31/53) of stage 2, 85.2% (69/81) of stage 3, and 92.3% (24/26) of stage 4 patients with bronchial carcinoma. Furthermore, the mean CEA levels increased with stage of disease, and the differences between mean levels were found to be significant in stages 1 and 2 versus 3 and 4 (p less than 0.001). This suggests a positive correlation between the preoperative CEA level and tumour burden defined by pathological staging. When the results were compared with the histological type of lung carcinoma, CEA elevations occurred most frequently with adenocarcinoma, followed by undifferentiated and squamous cell carcinoma, reflecting perhaps the origin of this oncofetal antigen from the endodermally derived bronchial mucosa. These data indicate that preoperative serum CEA levels quantitatively reflect the extent of tumour assessed pathologically at operation and confirm the potential usefulness of this antigen as a biological tumour marker in the management of bronchial neoplasms.     

Transsphenoidal surgery for acromegaly: endocrinological follow-up of 98 patients

OBJECTIVE: Transsphenoidal surgery is the preferred treatment modality for growth hormone (GH)-secreting pituitary adenomas. In many series, the reported postoperative remission is based mainly on achievement of GH levels less than 2 ng/ml. Strict criteria for insulin-like growth factor I normalization and even lower GH levels (<1 ng/ml) are now suggested to define cure of acromegaly, but the evidence does not yet support such low GH levels in epidemiological follow-up. We analyzed our postoperative results in a large cohort of patients with acromegaly. METHODS: Ninety-eight patients harboring GH-secreting adenomas (46 microadenomas and 52 macroadenomas) underwent transsphenoidal surgery between 1990 and 1999. Ninety-one patients were operated for the first time, and 12 patients underwent reoperations because of previous surgical failure (7 had undergone surgery elsewhere previously). Biochemical remission was defined as a repeated fasting or glucose-suppressed GH level of 2 ng/ml or less, and a normal insulin-like growth factor I level. RESULTS: Remission was achieved in 74% of all patients after one operation, including 84% of patients with microadenomas and 64% of patients with macroadenomas. Seventy-three percent of patients with macroadenomas 11 to 20 mm in size achieved remission, as compared with a 20% remission rate for patients with adenomas larger than 20 mm. Patients with preoperative random GH levels lower than 50 ng/ml had a better outcome (85% remission), whereas GH greater than 50 ng/ml was associated with remission in 30% of the patients. Only one of the patients (8%) with postoperative active disease who underwent a second operation achieved remission. Recurrence was rare (one patient), and all failed surgical attempts could be detected during the immediate postoperative evaluation. CONCLUSION: On the basis of strict postoperative GH and insulin-like growth factor I criteria to define remission, our series demonstrates the efficacy of transsphenoidal surgery for acromegalic patients with microadenomas and noninvasive macroadenomas. However, patients with large adenomas (>20 mm) and preoperative GH greater than 50 ng/ml have a poor prognosis and require adjunctive medical or radiation therapy to control GH hypersecretion.